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J Neurol Surg A Cent Eur Neurosurg 2017; 78(02): 180-190
DOI: 10.1055/s-0036-1592158
Review Article
Georg Thieme Verlag KG Stuttgart · New York

Effectiveness and Adverse Effects of Deep Brain Stimulation: Umbrella Review of Meta-Analyses

Panagiotis N. Papageorgiou
1   Department of Neurosciences, Southampton University Hospital, Southampton, United Kingdom
,
James Deschner
2   Section of Experimental Dento-Maxillo-Facial Medicine, School of Dentistry, University of Bonn, Bonn, Germany
,
Spyridon N. Papageorgiou
3   Department of Orthodontics, School of Dentistry, University of Bonn, Bonn, Germany
4   Department of Oral Technology, School of Dentistry, University of Bonn, Bonn, Germany
› Author Affiliations
Further Information

Publication History

04 January 2016

22 July 2016

Publication Date:
19 September 2016 (online)

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Abstract

Background This umbrella review summarizes the evidence across meta-analyses regarding the effectiveness and adverse effects of deep brain stimulation (DBS).

Methods Databases were searched up to March 2015 for meta-analyses of comparative trials in humans assessing the effectiveness or adverse effects of DBS. Data selection, data extraction, and risk of bias assessment were performed by two independent reviewers.

Results Seven eligible systematic reviews were included assessing the use of DBS for epilepsy (n = 1), obsessive-compulsive disorder (n = 1), and Parkinson disease (n = 5). The summary estimates were significant at p ≤ 0.05 in four meta-analyses (27%) with both fixed and random effects. One meta-analysis reported that DBS was more effective than sham in reducing the Yale-Brown Obsessive Compulsive Scale score in obsessive-compulsive disorder patients. The remaining three meta-analyses reported differences regarding mortality and depression in patients with Parkinson disease between DBS of the subthalamic nucleus and of the globus pallidus internus. Of the 15 meta-analyses, none compiled adequately robust evidence.

Conclusions Although DBS has emerged as a viable surgical intervention to treat various disabling neurologic symptoms, existing studies fail to adequately support its use based on robust evidence without hints of bias.

Keywords

deep brain stimulation - Parkinson disease - epilepsy - obsessive-compulsive disorder - systematic review - meta-analysis

Supplementary Material

 

  • References

  • 1 Limousin P, Krack P, Pollak P , et al. Electrical stimulation of the subthalamic nucleus in advanced Parkinson's disease. N Engl J Med 1998; 339 (16) 1105-1111
    CrossrefPubMedGoogle Scholar
  • 2 Kleiner-Fisman G, Herzog J, Fisman DN , et al. Subthalamic nucleus deep brain stimulation: summary and meta-analysis of outcomes. Mov Disord 2006; 21 (Suppl. 14) S290-S304
    CrossrefPubMedGoogle Scholar
  • 3 Perlmutter JS, Mink JW. Deep brain stimulation. Annu Rev Neurosci 2006; 29: 229-257
    CrossrefPubMedGoogle Scholar
  • 4 Plaha P, Patel NK, Gill SS. Stimulation of the subthalamic region for essential tremor. J Neurosurg 2004; 101 (1) 48-54
    CrossrefPubMedGoogle Scholar
  • 5 Bittar RG, Kar-Purkayastha I, Owen SL , et al. Deep brain stimulation for pain relief: a meta-analysis. J Clin Neurosci 2005; 12 (5) 515-519
    CrossrefPubMedGoogle Scholar
  • 6 Visser-Vandewalle V, Temel Y, Boon P , et al. Chronic bilateral thalamic stimulation: a new therapeutic approach in intractable Tourette syndrome. Report of three cases. J Neurosurg 2003; 99 (6) 1094-1100
    CrossrefPubMedGoogle Scholar
  • 7 Greenberg BD, Gabriels LA, Malone Jr DA , et al. Deep brain stimulation of the ventral internal capsule/ventral striatum for obsessive-compulsive disorder: worldwide experience. Mol Psychiatry 2010; 15 (1) 64-79
    Google Scholar
  • 8 Lozano AM, Mayberg HS, Giacobbe P, Hamani C, Craddock RC, Kennedy SH. Subcallosal cingulate gyrus deep brain stimulation for treatment-resistant depression. Biol Psychiatry 2008; 64 (6) 461-467
    CrossrefPubMedGoogle Scholar
  • 9 Schlaepfer TE, Bewernick BH. Deep brain stimulation for major depression. Handb Clin Neurol 2013; 116: 235-243
    PubMedGoogle Scholar
  • 10 Schlaepfer TE, Lieb K. Deep brain stimulation for treatment of refractory depression. Lancet 2005; 366 (9495): 1420-1422
    CrossrefPubMedGoogle Scholar
  • 11 Wu H, Van Dyck-Lippens PJ, Santegoeds R , et al. Deep-brain stimulation for anorexia nervosa. World Neurosurg 2013; 80 (3–4): 29.e1-29.e10
    PubMedGoogle Scholar
  • 12 Hanajima R, Ashby P, Lozano AM, Lang AE, Chen R. Single pulse stimulation of the human subthalamic nucleus facilitates the motor cortex at short intervals. J Neurophysiol 2004; 92 (3) 1937-1943
    CrossrefPubMedGoogle Scholar
  • 13 Uc EY, Follett KA. Deep brain stimulation in movement disorders. Semin Neurol 2007; 27 (2) 170-182
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Guyatt GH, Oxman AD, Schünemann HJ, Tugwell P, Knottnerus A. GRADE guidelines: a new series of articles in the Journal of Clinical Epidemiology. J Clin Epidemiol 2011; 64 (4) 380-382
    CrossrefPubMedGoogle Scholar
  • 15 Shea BJ, Grimshaw JM, Wells GA , et al. Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol 2007; 7: 10
    CrossrefPubMedGoogle Scholar
  • 16 Whiting P, Savović J, Higgins JP , et al. ROBIS: A new tool to assess risk of bias in systematic reviews was developed. J Clin Epidemiol 2016; 69: 225-234
    CrossrefPubMedGoogle Scholar
  • 17 DerSimonian R, Laird N. Meta-analysis in clinical trials. Control Clin Trials 1986; 7 (3) 177-188
    CrossrefPubMedGoogle Scholar
  • 18 Riley RD, Higgins JP, Deeks JJ. Interpretation of random effects meta-analyses. BMJ 2011; 342: d549
    CrossrefPubMedGoogle Scholar
  • 19 Higgins JP, Thompson SG. Quantifying heterogeneity in a meta-analysis. Stat Med 2002; 21 (11) 1539-1558
    CrossrefPubMedGoogle Scholar
  • 20 Orsini N, Bottai M, Higgins J , et al. Heterogi: Stata module to quantify heterogeneity in a meta-analysis. Statistical Software Components 2006. Available at: http://www.EconPapers.repec.org/RePEc:boc:bocode:s449201 . Accessed March 15, 2015
    PubMedGoogle Scholar
  • 21 Papageorgiou SN, Xavier GM, Cobourne MT. Basic study design influences the results of orthodontic clinical investigations. J Clin Epidemiol 2015; 68 (12) 1512-1522
    CrossrefPubMedGoogle Scholar
  • 22 Thompson SG, Sharp SJ. Explaining heterogeneity in meta-analysis: a comparison of methods. Stat Med 1999; 18 (20) 2693-2708
    CrossrefPubMedGoogle Scholar
  • 23 Knapp G, Hartung J. Improved tests for a random effects meta-regression with a single covariate. Stat Med 2003; 22 (17) 2693-2710
    CrossrefPubMedGoogle Scholar
  • 24 Higgins JP, Thompson SG. Controlling the risk of spurious findings from meta-regression. Stat Med 2004; 23 (11) 1663-1682
    CrossrefPubMedGoogle Scholar
  • 25 Cohen J. Statistical Power Analysis for the Behavioral Sciences. 2nd ed. New York, NY: Academic Press; 1988
    Google Scholar
  • 26 Sterne JA, Sutton AJ, Ioannidis JP , et al. Recommendations for examining and interpreting funnel plot asymmetry in meta-analyses of randomised controlled trials. BMJ 2011; 343: d4002
    CrossrefPubMedGoogle Scholar
  • 27 Egger M, Davey Smith G, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997; 315 (7109): 629-634
    CrossrefPubMedGoogle Scholar
  • 28 Harbord RM, Egger M, Sterne JA. A modified test for small-study effects in meta-analyses of controlled trials with binary endpoints. Stat Med 2006; 25 (20) 3443-3457
    CrossrefPubMedGoogle Scholar
  • 29 Johnson VE. Revised standards for statistical evidence. Proc Natl Acad Sci U S A 2013; 110 (48) 19313-19317
    CrossrefPubMedGoogle Scholar
  • 30 Theodoratou E, Tzoulaki I, Zgaga L, Ioannidis JP. Vitamin D and multiple health outcomes: umbrella review of systematic reviews and meta-analyses of observational studies and randomised trials. BMJ 2014; 348: g2035
    CrossrefPubMedGoogle Scholar
  • 31 Arnaout M, Negida A, El Ashal G , et al. Meta-analysis comparing subthalamic and pallidal deep brain stimulation for patients with Parkinson's disease. Paper presented at: Association of Surgeons in Training International Conference; February 27–March 1, 2015; Glasgow, UK
    PubMedGoogle Scholar
  • 32 Chambers A, Bowen JM. Electrical stimulation for drug-resistant epilepsy: an evidence-based analysis. Ont Health Technol Assess Ser 2013; 13 (18) 1-37
    PubMedGoogle Scholar
  • 33 Kisely S, Hall K, Siskind D, Frater J, Olson S, Crompton D. Deep brain stimulation for obsessive-compulsive disorder: a systematic review and meta-analysis. Psychol Med 2014; 44 (16) 3533-3542
    CrossrefPubMedGoogle Scholar
  • 34 Liu Y, Li W, Tan C , et al. Meta-analysis comparing deep brain stimulation of the globus pallidus and subthalamic nucleus to treat advanced Parkinson disease. J Neurosurg 2014; 121 (3) 709-718
    CrossrefPubMedGoogle Scholar
  • 35 Negida A, Arnaout M, El Ashal G , et al. Meta-analysis of mortality following subthalamic and pallidal deep brain stimulation for patients with Parkinson's disease. Paper presented at: ASiT conference; February 27–March 1, 2015; Glasgow, UK
    PubMedGoogle Scholar
  • 36 Sako W, Miyazaki Y, Izumi Y, Kaji R. Which target is best for patients with Parkinson's disease? A meta-analysis of pallidal and subthalamic stimulation. J Neurol Neurosurg Psychiatry 2014; 85 (9) 982-986
    CrossrefPubMedGoogle Scholar
  • 37 Sprengers M, Vonck K, Carrette E, Marson AG, Boon P. Deep brain and cortical stimulation for epilepsy. Cochrane Database Syst Rev 2014; 6 (6) CD008497
    PubMedGoogle Scholar
  • 38 Borcherding BG, Keysor CS, Rapoport JL, Elia J, Amass J. Motor/vocal tics and compulsive behaviors on stimulant drugs: is there a common vulnerability?. Psychiatry Res 1990; 33 (1) 83-94
    CrossrefPubMedGoogle Scholar
  • 39 Vulink NC, Denys D, Fluitman SB, Meinardi JC, Westenberg HG. Quetiapine augments the effect of citalopram in non-refractory obsessive-compulsive disorder: a randomized, double-blind, placebo-controlled study of 76 patients. J Clin Psychiatry 2009; 70 (7) 1001-1008
    CrossrefPubMedGoogle Scholar
  • 40 Figee M, de Koning P, Klaassen S , et al. Deep brain stimulation induces striatal dopamine release in obsessive-compulsive disorder. Biol Psychiatry 2014; 75 (8) 647-652
    CrossrefPubMedGoogle Scholar
  • 41 Hamani C, Pilitsis J, Rughani AI , et al; American Society for Stereotactic and Functional Neurosurgery; Congress of Neurological Surgeons; CNS and American Association of Neurological Surgeons. Deep brain stimulation for obsessive-compulsive disorder: systematic review and evidence-based guideline sponsored by the American Society for Stereotactic and Functional Neurosurgery and the Congress of Neurological Surgeons (CNS) and endorsed by the CNS and American Association of Neurological Surgeons. Neurosurgery 2014; 75 (4) 327-333 ; quiz 333
    CrossrefPubMedGoogle Scholar
  • 42 Follett KA, Weaver FM, Stern M , et al; CSP 468 Study Group. Pallidal versus subthalamic deep-brain stimulation for Parkinson's disease. N Engl J Med 2010; 362 (22) 2077-2091
    CrossrefPubMedGoogle Scholar
  • 43 Odekerken VJ, van Laar T, Staal MJ , et al. Subthalamic nucleus versus globus pallidus bilateral deep brain stimulation for advanced Parkinson's disease (NSTAPS study): a randomised controlled trial. Lancet Neurol 2013; 12 (1) 37-44
    CrossrefPubMedGoogle Scholar
  • 44 Doorn KJ, Lucassen PJ, Boddeke HW , et al. Emerging roles of microglial activation and non-motor symptoms in Parkinson's disease. Prog Neurobiol 2012; 98 (2) 222-238
    CrossrefPubMedGoogle Scholar
  • 45 Ferrer I, López-Gonzalez I, Carmona M, Dalfó E, Pujol A, Martínez A. Neurochemistry and the non-motor aspects of PD. Neurobiol Dis 2012; 46 (3) 508-526
    CrossrefPubMedGoogle Scholar
  • 46 Meissner WG. When does Parkinson's disease begin? From prodromal disease to motor signs. Rev Neurol (Paris) 2012; 168 (11) 809-814
    CrossrefPubMedGoogle Scholar
  • 47 Papageorgiou SN. Meta-analysis for orthodontists: Part II—Is all that glitters gold?. J Orthod 2014; 41 (4) 327-336
    CrossrefPubMedGoogle Scholar
  • 48 Papageorgiou SN. Meta-analysis for orthodontists: Part I—How to choose effect measure and statistical model. J Orthod 2014; 41 (4) 317-326
    CrossrefPubMedGoogle Scholar
  • 49 Papageorgiou SN, Tsiranidou E, Antonoglou GN, Deschner J, Jäger A. Choice of effect measure for meta-analyses of dichotomous outcomes influenced the identified heterogeneity and direction of small-study effects. J Clin Epidemiol 2015; 68 (5) 534-541
    CrossrefPubMedGoogle Scholar
  • 50 Belbasis L, Bellou V, Evangelou E, Ioannidis JP, Tzoulaki I. Environmental risk factors and multiple sclerosis: an umbrella review of systematic reviews and meta-analyses. Lancet Neurol 2015; 14 (3) 263-273
    CrossrefPubMedGoogle Scholar
  • 51 Tsilidis KK, Kasimis JC, Lopez DS, Ntzani EE, Ioannidis JP. Type 2 diabetes and cancer: umbrella review of meta-analyses of observational studies. BMJ 2015; 350: g7607
    CrossrefPubMedGoogle Scholar
  • 52 Bergey GK, Morrell MJ, Mizrahi EM , et al. Long-term treatment with responsive brain stimulation in adults with refractory partial seizures. Neurology 2015; 84 (8) 810-817
    CrossrefPubMedGoogle Scholar
  • 53 Volkmann J, Mueller J, Deuschl G , et al; DBS study group for dystonia. Pallidal neurostimulation in patients with medication-refractory cervical dystonia: a randomised, sham-controlled trial. Lancet Neurol 2014; 13 (9) 875-884
    CrossrefPubMedGoogle Scholar
  • 54 Pedrosa DJ, Auth M, Pauls KA , et al. Verbal fluency in essential tremor patients: the effects of deep brain stimulation. Brain Stimulat 2014; 7 (3) 359-364
    CrossrefPubMedGoogle Scholar
  • 55 Olazarán J, González B, López-Álvarez J , et al. Motor effects of REAC in advanced Alzheimer's disease: results from a pilot trial. J Alzheimers Dis 2013; 36 (2) 297-302
    CrossrefPubMedGoogle Scholar
  • 56 Ramasubbu R, Anderson S, Haffenden A, Chavda S, Kiss ZH. Double-blind optimization of subcallosal cingulate deep brain stimulation for treatment-resistant depression: a pilot study. J Psychiatry Neurosci 2013; 38 (5) 325-332
    CrossrefPubMedGoogle Scholar